<!Doctype html>
<html lang="en">
<head>
	<meta charset="UTF-8" />
	<title>Zadacha 1 Forms</title>
</head>
<body>
<form method="post">
	<table>
	
		<tr>
			<td>
				<label for="LastName">Last Name:</label>
			</td>
			
			<td colspan="3">
				<input type="text" name="LastName" placeholder="LastName" id="LastName" required="required"/>
			</td>
		</tr>
		
		<tr>
			<td>
				<label for="FirstName">First Name:</label>
			</td>
			
			<td colspan="3">
				<input type="text" name="FirstName" placeholder="FirstName" id="FirstName" required="required"/>
			</td>
		</tr>
		
		<tr>
			<td>
				<label for="Address">Address:</label>
			</td>
			
			<td colspan="3">
				<textarea  name="Address" placeholder="Text" id="Address" required="required"></textarea> 
			</td>
		</tr>
		
		<tr>
			<td>
				<label for="City">City:</label>
			</td>
			
			<td>
				<input type="text" name="City" placeholder="City" id="City" required="required"/>
			</td>
			
			<td>
				<label for="State">State</label>
			</td>
			
			<td>
				<input type="text" name="State" id="State" placeholder="State" required="required" />
			</td>	
		</tr>
		
		<tr>
			<td>
				<label for="ZipCode">Zip/Postal Code:</label>
			</td>
			
			<td colspan="3">
				<input type="text" name="ZipCode" placeholder="Zip Code" id="ZipCode" required="required"/>
			</td>
		</tr>
		
		<tr>
			<td>
				<label for="Country">Country</label>
			</td>
			
			<td colspan="3">
				<select name="Country" id="Country">
					<option value="Bg" selected="selected">Bulgaria</option>
					<option value="Eng" >England</option>
					<option value="Rus" >Russia</option>
				</select>
			</td>
		</tr>
		
		<tr>
			<td>
				<label for="Phone">Phone(Counry code,area code,number)</label>
			</td>
			
			<td colspan="3">
				(+<input type="text" name="Ccode" id="Phone" placeholder="359" required="required"/>)
				<input type="text" name="Acode" id="Phone1" placeholder="00" required="required" />-
				<input type="text" name="Ncode" id="Phone2" placeholder="0000000" required="required" />
			</td>
		</tr>
		
		<tr>
			<td>
				<label for="Email">Email:</label>
			</td>
			
			<td colspan="3">
				<input type="text" name="Email" id="Email" placeholder="Sample@abv.bg" required="required" />
			</td>
		</tr>
		
		<tr>
			<td>
				<label for="Month" >Birth date</label>
			</td>
			
			<td colspan="3">
				<label for="Month" >Month</label>
				<input type="text" name="Month" id="Month" placeholder="**" required="required" />
				
				<label for="Day" >Day</label>
				<input type="text" name="Day" id="Day" placeholder="**" required="required" />
				
				<label for="Yaer" >Yaer(4 digit)</label>
				<input type="text" name="Yaer" id="Yaer" placeholder="****" required="required" />
			</td>
		</tr>
		
		<tr>
			<td>
				<label for="Gender" >Gender</label>
			</td>
			
			<td colspan="3">
				<select name="Gender" id="Gender">
					<option value="Male" selected="selected">Male</option>
					<option value="Female">Female</option>
				</select>
			</td>
		</tr>
		
		<tr>
			<td>
				<div>Staring date</div>
			</td>
			
			<td colspan="3">
				
				<label for="Spring">Spring 2006</label>	
				<input type="radio" name="SDate" value="Spring 2006" id="Spring" />
				
				<label for="Summer">Summer 2006</label>
				<input type="radio" name="SDate" value="Summer 2006" id="Summer" />
			</td>
		</tr>
		
		<tr>
			<td>
				<label for="Question" >Comment/Question</label>
			</td>
			
			<td colspan="3" >
				<textarea name="Question" id="Question"></textarea>
			</td>
		</tr>
		
		<tr>
			<td colspan="4">
				
				<input type="submit" name="SumbitBtn" id="Submit" value="Submit"/>
				<input type="reset"  id="Reset" value="Clear Form"/>
			
			</td>
		</tr>
	
	</table>
</form>	
</body>
</html>